Provider Demographics
NPI:1043624968
Name:SPIRIT WALK LLC
Entity Type:Organization
Organization Name:SPIRIT WALK LLC
Other - Org Name:SPIRIT WALK LLC - FAMILY AND WOMEN'S WELLNESS CLINIC/STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERROTTO ZULTOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LMT, LMI, RYT
Authorized Official - Phone:832-419-8286
Mailing Address - Street 1:1776 WOODSTEAD CT
Mailing Address - Street 2:SUITE 104
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380
Mailing Address - Country:US
Mailing Address - Phone:281-466-2585
Mailing Address - Fax:
Practice Address - Street 1:1776 WOODSTEAD CT
Practice Address - Street 2:SUITE 104
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:281-466-2585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty